Luchenski, Serena; (2024) The preventative role of hospitals for people experiencing homelessness in England: a mixed methods study. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

People experiencing homelessness endure some of the worst outcomes and greatest inequities in society. Poor access to primary and preventative care frequently leads to high rates of emergency hospital care. This is a critical time to ‘make every contact count,’ but people’s needs are often not addressed holistically to prevent future ill health. My research is about how hospitals can take a more integrated and preventative approach to the care of people experiencing homelessness when they attend NHS hospitals in England. Homelessness is not routinely recorded in hospital records, so I developed a new way of estimating the number of hospital admissions. I estimated that there were 176,342 [95% CI 164,031 – 188,654] admissions for people experiencing homelessness in 2017/18 in England. This is about five times as many admissions as I could directly count in the data. Hospital treatment for people experiencing homelessness was most often provided for mental health and substance use, infections, injuries, and skin diseases. Compared to people who were housed, there were pervasive needs and extreme inequities across all measures of physical and psychosocial health for people experiencing homelessness. I reviewed the literature on hospital-based preventative interventions to help address these health needs. Interventions with multiple strategies, including care coordination, advocacy, support, outreach, social welfare assistance, and discharge planning were the most evidence based. I interviewed people experiencing homelessness and key stakeholders about their views and experiences of hospital care and prevention. They provided insights on the problems they have experienced and the impacts, strategies for a more preventative approach, and barriers/facilitators to implementation of preventative interventions in hospitals. I integrated all my findings into a public health strategic planning framework to guide policy, practice, and future research. My research can help inform future health needs assessments, preventative intervention development, and implementation strategies for a more preventative and integrated approach to hospital care for people experiencing homelessness in England.

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